Asthma and related MCQs by Dr chaitanya Joshi

Asthma lecture ppt Outline

Asthma inhaler MDI device

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Table of contents (toc)

--Dr Chaitanya Joshi

Introduction of asthma

    Asthma is a Chronic inflammatory condition of airway Characterized by

• 1. airway limitation: reversible
• 
  
• 2. airway hyperresponsiveness
• 
  
• 3. inflammation of bronchi T cell mediated, eosinophilic, hypertrophy, mucus plugging

Classification of asthma

Extrinsic asthma

• Atopy (allergy)
• Positive skin prick test
• Childhood asthma a/w eczema

Intrinsic asthma

• Middle age
• No cause
• May show positive skin prick test
• External stimuli sensitization like toulene, NSAIDs,  beta blockers etc
• Etiology and precipitating factors

Clinical features of asthma

• Typical recurrent episodes with normal life in between
• Wheezing
• SOB
• Chest tightness
• Cough
• Classical diurnal pattern with symptoms worse in morning and night
• Cough and wheeze disturb sleep – nocturnal asthma

Diagnosis of asthma

• Mostly clinical diagnosis
• Symptoms improvement following bronchodilator and corticosteroid
• Diurnal variation on 3 days a week for 2 weeks on PEF diary
• PEF decrease after 6 min of exercise
• Investigations 
• PFT
• Exercise test
• Histamine or methacholine bronchial provocation test
• Corticosteroids trial
• Exhaled NO test
• Blood and sputum workup
• CXR
• Skin prick test for allergen

Management of asthma- treatment of asthma

Symptoms control for asthma

• Restore normal lifestyle
• Reduce risk of recurrent and severe attacks
• Enable normal growth and nutrition
• Family education and counselling
• Avoid under or overtreatment

Extrinsic factor control for asthma

• Pet
• Dust
• Smoke
• Medicine like NSAID, antibiotics
• Allergens
• Pollens 
• Pharmacological treatment
• Step down therapy
• Once control established, dose of corticosteroid titrated to the lowest dose 
• 
  
• Decreasing dose of ICS around 25-50% every 3 months, a reasonable strategy for many

AE of asthma

• Aka acute severe asthma
• Treatment done at ER or on the way
• Bronchodilators, nebulization, high dose steroids etc.
• May even lead to death if not treated on time
• Pack year calculation

Flapping tremor

• Please refer to the slides

Fine tremor

• Please refer to the slides

Drugs used for asthma

• Please refer to the slides

Modified MRC scale of SOB

• Please refe to the slides below

COPD types

Two classical phenotypes

• Pink puffers: Thin, breathless and maintain a normal PaCO2 until the late stage of disease Emphysema, Compensated by hyperventilation, so ABG is normal

• Blue bloaters: Hypercapnia> Early stage, Chronic bronchitis, Due to obstruction Co2 retention, may develop oedema and secondary polycythaemia

Barrel chest

Please refer to the slides

Multiple Choice Questions  related to respiratory system

• What is asthma attack?

• When the lungs is filled with water 

• When airways tighten and the lungs don’t get enough air

• When the heart beats too fast 

• When the heart and lungs are working too hard 

Ans: b (When airways tighten and the lungs don’t get enough air)

2. Which of the following is not the characteristic of asthma? 

• Increase in IgG immunoglobulins 

• Airway hyperresponsiveness 

• Infiltration of eosinophils into the airways 

• Increased mucus production

Ans: a (Increase in IgG immunoglobulins)

3. The immediate response of asthma involves: 

• Mast cell degranulation 

• Binding of antigen to IgE on macrophages

• Release of cytokines 

• Activation of cholinergic nerves

Ans: a (Mast cell degranulation)

4.  Chronic asthma is associated with:  

• Activation of T lymphocytes 

• Reduced function of goblet cells 

• Activation of eosinophils 

• Decreased permeability of submucosal capillaries 

Ans: c (Activation of eosinophils)

5. Which test is NOT used during diagnosis of asthma? 

• Diffusing capacity 

• Peak expiratory flow rate 

• Bronchodilator challenge test 

• Skin prick test

Ans: a (Diffusing capacity)

6. A diagnosis of severe asthma should be made after about how many months of uncontrolled asthma?

• 1 month 

• 3-6 months 

• 6-9 months 

• More than 9 months 

Ans: b (3-6 months)

7. When a patient is diagnoses with severe asthma, which of the following is recommended?

• Referral to specialist 

• Increased dosage of patient’s current medication 

• Education about risk factors and triggers such as smoking

• Treatment of comorbidities and triggers such as smoking

Ans: a (Referral to specialist)

8. Which drug is most commonly prescribed preventer therapy in asthma? 

• Beta2 adrenoreceptor agonists 

• Xanthine such as theophylline 

• Muscarinic receptor antagonists

• Inhaled steroids 

Ans: d (Inhaled steroids)

  

9. Once a patient is diagnosed with asthma and referred to specialist, what does GINA recommend next step? 

• Referral to mental health professional 

• Increased dosage of patient’s current medication 

• Assessment of patient’s inflammatory phenotype 

• Hospitalization for intense observation

Ans: c (Assessment of patient’s inflammatory phenotype)

10. Acute management of asthma include all of the following, EXCEPT: 

• A high concentration of oxygen to achieve oxygen saturation of >90%

• Short acting beta-2- agonists 

• A slow infusion of aminophylline with monitoring blood values 

• A rapid infusion of dopamine 

Ans: d (A rapid infusion of dopamine)

Thank you!

A doctor viewing x-ray of asthma patient

Thank you very much